铜川市王益区自然人群结直肠癌筛查结果分析

Analysis of colorectal cancer in natural population in Wangyi district of Tongchuan city

目的:探索铜川市王益区自然人群结直肠癌的发病情况,并通过积极干预降低结直肠癌的发病率和死亡率。方法:于2013年3月启动铜川市王益区结直肠癌早诊早治筛查工作,采用危险因素量化评估问卷调查表调查结合大便隐血试验(FOBT)的初筛和结肠镜检查的复筛结合作为结直肠癌筛查方案。结果:在应参加筛查的48 254人中,实际参加问卷调查29 580人,顺应率为61.30%(29 580/48 254);实际大便检查人数24 672人,顺应率为51.13%(24 672/48 254)。初筛确定结直肠癌高危人群5 842人,占筛查人数的19.75%(5 842/29 580)。初筛确定结直肠癌高危人群5 842人中有4 214人进一步做电子肠镜检查,顺应率为72.13%(4 214/5 842),检出肠道病变825例,检出率为19.58%(825/4 214)。从性别分布情况分析:男性结直肠病变的检出率显著高于女性(χ~2=248.260,P=0.000);从年龄分布情况分析:各年龄组结直肠病变检出率相比,差异具有统计学意义(χ~2=120.625,P=0.000);从病理类型和部位分布情况分析:病理类型所占比重从大到小依次为息肉(50.42%)、管状腺瘤(32.36%)、绒毛状腺瘤(7.15%)、高级别瘤变(6.30%)、结直肠癌(3.76%);直肠病变分布所占比重从大到小依次为乙状结肠(27.64%)、直肠(24.36%)、降结肠(11.88%)、升结肠(10.55%)、横结肠(9.21%)、肝曲(6.30%)、脾曲(5.21%)、回盲部(4.85%)。结论:通过开展本次结直肠癌早诊早治筛查工作,有助于提高结直肠早期癌变的诊断率,同时也为本市癌症筛查工作的开展积累了经验。

Objective：To explore the incidence of colorectal cancer in the natural population in Wangyi district of Tongchuan city, and to reduce the incidence and mortality rates of colorectal cancer through active intervention. Meth- ods ：The preliminary colorectal cancer screening was carried out to the residents aged from 40 to 74 years old with the risk evaluation questionnaire and FOBT in Tongchuan city in 2013. Colonoscopy was performed among the high risk population obtained from the preliminary screening and their results were analyzed. Results：The target population for colorectal cancer screening was for 48 254 people, including complete medical history questionnaire in 29 580 cases, and compliance rate was 61.30% （29 580/48 254）. The actual number of 24 672 people participated in stool exami- nation,and compliance rate was 51.13% （24 672/48 254）. 4 214 persons were examined by colonoseopy in 5 842 people with high risk of colorectal cancer, and the detection rate of intestinal lesion was 19.58% （825/4 214 ）. Men eolorectal lesion detection rate was significantly higher than women （ X2 = 248. 260, P = 0. 000 ）. In coloreetal lesion detection rate of age group ,the difference was statistically significant（ X2 =120. 625, P = 0. 000 ）. Pathological types about proportions in descending order were polyps （ 5 0.4 2 % ） , tubular adenoma （ 3 2.3 6 % ） , villous adenoma （7.15%） , the high - level neoplasia （ 6.3 0 % ） , coloreetal cancer （ 3.7 6 % ） . Rectal lesions distribution aboutproportions in decreasing order were the sigmoid colon （27.64%）, rectum（24.36% ）, descending colon （ 11.88% ）, ascending colon （ 10.55 % ） , transverse colon （ 9.21% ）, hepatic flexure （ 6.30% ） , splenic flexure （ 5.21% ）, ileocecal （4.85 % ）. Conclusion：The incidence of colorectal cancer in middle aged and old aged in urban population was ris- ing sharply. After screening using fecal occult blood test, patients who have positive results should be examined by colonoscopy and early colorectal can be detected. We suggest that this work should be performed widely in urban pop- ulation to improve the prognosis of colorectal cancer.